CoronaBro Meltdown/SARS-Covid-19 Spitballing Thread

[steve dave]

https://twitter.com/BillyCorben/status/1241740081343447040?s=19

jesus christ

[Justwin]

Who is this rough ridin' guy ugh

Do you not like rationally evaluating policies?

[Justwin]

do your back-of-the-envelope calculations take into account the reduced QALYs of someone with pulmonary fibrosis and reduced lung function? I'm pretty sure your "model" was making an assumption that 100% of people who recover do so completely. That is a false assumption.

Absolutely you can adjust for that.  Just like how you adjust for people being in nursing homes, having multiple comorbities, etc. reduces the QALYs you gain if you save their life.

[Justwin]

Ok but now convert that to # of deaths so we have an apples to apples comparison.

Catastrophe: less than 65,000 projected US deaths would not justify the current protective measures. (CDC estimates our worst recent flu season to be responsible for 61,000)

Justwin: more than ______ projected US deaths would justify the current protective measures.

It's just not a headline death number.  It depends on the average life expectancy of the people that are being affected.  Given the average age and average condition of those being affected, it would be probably take 1-2 million deaths (maybe even more) averted to make everything worth it.

[Justwin]

what's your guess on the marginal cost of the containment strategies we have currently implemented?

In the end, it will probably be $1.5-$3.0 trillion.  That is not including the non-monetary costs, though.

My point is not that I have a model that has all of the answers.  My point is that until you show me a model that appropriately accounts for all of the costs and weighs that against the potential benefits, I'm not going to support your efforts as president, governor, etc. to implement lock downs, cancel schools, shut businesses down, etc.  And if your model is using things like a 3.4% CFR (or higher), I'm certainly not going to believe what you are saying.

[steve dave]

what's your guess on the marginal cost of the containment strategies we have currently implemented?

In the end, it will probably be $1.5-$3.0 trillion.  That is not including the non-monetary costs, though.

My point is not that I have a model that has all of the answers.  My point is that until you show me a model that appropriately accounts for all of the costs and weighs that against the potential benefits, I'm not going to support your efforts as president, governor, etc. to implement lock downs, cancel schools, shut businesses down, etc.  And if your model is using things like a 3.4% CFR (or higher), I'm certainly not going to believe what you are saying.

ok, the bad news is that nobody is ever getting justwin's support for any single rough ridin' thing that ever has, will, or could happen. the good news is you can quit listening or talking to him.

[Justwin]

what's your guess on the marginal cost of the containment strategies we have currently implemented?

In the end, it will probably be $1.5-$3.0 trillion.  That is not including the non-monetary costs, though.

My point is not that I have a model that has all of the answers.  My point is that until you show me a model that appropriately accounts for all of the costs and weighs that against the potential benefits, I'm not going to support your efforts as president, governor, etc. to implement lock downs, cancel schools, shut businesses down, etc.  And if your model is using things like a 3.4% CFR (or higher), I'm certainly not going to believe what you are saying.

ok, the bad news is that nobody is ever getting justwin's support for any single rough ridin' thing that ever has, will, or could happen. the good news is you can quit listening or talking to him.

It's really not that hard for the head of a government to have a model designed to account for these things.  This is what happens all the time when it comes to tax policy, the ACA and other government policy.  It's how NICE in the UK makes decisions (with a willingess to pay for a QALY of $50,000).  However, the way that things are being decided right now is completely driven by public health types that don't worry about the costs.  They just focus on stopping the disease.  Government officials are playing on people's fear of the unknown to exercise their power.

"I don't think that anybody should second guess the government's actions," Mnuchin said. "This has been moving very quickly and I think we've responded appropriately."

What a sentiment.

[catastrophe]

I mean maybe they did the math. Cause the estimated death toll reported to the WH was over the number you think would justify the measures we’re taking.

Sweeping new federal recommendations announced on Monday for Americans to sharply limit their activities appeared to draw on a dire scientific report warning that, without action by the government and individuals to slow the spread of coronavirus and suppress new cases, 2.2 million people in the United States could die.

https://www.nytimes.com/2020/03/16/us/coronavirus-fatality-rate-white-house.html

[michigancat]

Justwin, why are you using QALY's instead of value of statistical life? Just because you think it only impacts old people? value of statistical life seems much more relevant to pandemic poliicy than how QALY is used with NICE in the UK.

In the scientific literature, these estimates of willingness to pay for small reductions in mortality risks are often referred to as the "value of a statistical life.” This is because these values are typically reported in units that match the aggregate dollar amount that a large group of people would be willing to pay for a reduction in their individual risks of dying in a year, such that we would expect one fewer death among the group during that year on average. This is best explained by way of an example. Suppose each person in a sample of 100,000 people were asked how much he or she would be willing to pay for a reduction in their individual risk of dying of 1 in 100,000, or 0.001%, over the next year. Since this reduction in risk would mean that we would expect one fewer death among the sample of 100,000 people over the next year on average, this is sometimes described as "one statistical life saved.” Now suppose that the average response to this hypothetical question was $100. Then the total dollar amount that the group would be willing to pay to save one statistical life in a year would be $100 per person × 100,000 people, or $10 million. This is what is meant by the "value of a statistical life.” Importantly, this is not an estimate of how much money any single individual or group would be willing to pay to prevent the certain death of any particular person.

https://www.epa.gov/environmental-economics/mortality-risk-valuation

[Kat Kid]

My justwin meme

https://imgflip.com/i/3tlkin

[michigancat]

Also, if you make no policy changes, you're dealing with wartime-like ICU triage across the country because they'll be completely overrun. I don't know how you can predict the behavior of a population dealing with that when they haven't had any exposure to it at all, but I'm guessing it's not pretty. I haven't seen any of the "should we be shutting down?" articles address this.

In early March, as the coronavirus outbreak worsened in Italy, an Italian medical association issued guidelines finding that doctors might have to prioritize younger COVID-19 patients over older ones. "It may be necessary to place an age limit" on access to intensive care, the guidelines advised, with the goal of preserving limited health care resources for patients more likely to survive.

But age is rarely the only factor in such decision-making. For example, a 20-year-old will not always get priority over a 60-year-old, especially if that 20-year-old has additional health problems that could mean the 60-year-old is likely to live longer anyway. Scoring systems can disadvantage older patients, because as people age they become more susceptible to disease, which can hurt their clinical scores.

Another potential factor is "social usefulness," a concept that might favor, for example, a sick nurse because that person could go on to save other lives.

"Some people think that people who are in a position to help address a crisis in the future if they were to recover, like health care workers and first responders, maybe should receive some sort of priority in triaging scarce resources," said Emily Rubin, a pulmonary and critical care physician at Massachusetts General Hospital in Boston and a co-chair of the hospital's ethics committee.

https://www.npr.org/2020/03/21/819645036/u-s-hospitals-prepare-guidelines-for-who-gets-care-amid-coronavirus-surge

[michigancat]

My justwin meme

https://imgflip.com/i/3tlkin

lol

[Justwin]

I mean maybe they did the math. Cause the estimated death toll reported to the WH was over the number you think would justify the measures we’re taking.

Sweeping new federal recommendations announced on Monday for Americans to sharply limit their activities appeared to draw on a dire scientific report warning that, without action by the government and individuals to slow the spread of coronavirus and suppress new cases, 2.2 million people in the United States could die.

https://www.nytimes.com/2020/03/16/us/coronavirus-fatality-rate-white-house.html

The current measures being undertaken were not and are not going to save all of those people and current measures are not as severe as what is in the report.  Even in the report, they don't claim that all of those people are going to be saved. 

We find that that optimal mitigation policies (combining home isolation of suspect cases, home quarantine of those living in the same household as suspect cases, and social distancing of the
elderly and others at most risk of severe disease) might reduce peak healthcare demand by 2/3 and deaths by half. However, the resulting mitigated epidemic would still likely result in hundreds of
thousands of deaths and health systems (most notably intensive care units) being overwhelmed many times over.

Additionally, you have to implement these policies for 18 months to get the maximum number of deaths averted.  People will not stand for these measures enduring for many months, let alone for 18 months.  The report is also based on an IFR or CFR of 0.9%, which is likely double what it truly is.  This has a big impact on the potential benefits.

[Justwin]

Justwin, why are you using QALY's instead of value of statistical life? Just because you think it only impacts old people? value of statistical life seems much more relevant to pandemic poliicy than how QALY is used with NICE in the UK.

In the scientific literature, these estimates of willingness to pay for small reductions in mortality risks are often referred to as the "value of a statistical life.” This is because these values are typically reported in units that match the aggregate dollar amount that a large group of people would be willing to pay for a reduction in their individual risks of dying in a year, such that we would expect one fewer death among the group during that year on average. This is best explained by way of an example. Suppose each person in a sample of 100,000 people were asked how much he or she would be willing to pay for a reduction in their individual risk of dying of 1 in 100,000, or 0.001%, over the next year. Since this reduction in risk would mean that we would expect one fewer death among the sample of 100,000 people over the next year on average, this is sometimes described as "one statistical life saved.” Now suppose that the average response to this hypothetical question was $100. Then the total dollar amount that the group would be willing to pay to save one statistical life in a year would be $100 per person × 100,000 people, or $10 million. This is what is meant by the "value of a statistical life.” Importantly, this is not an estimate of how much money any single individual or group would be willing to pay to prevent the certain death of any particular person.

https://www.epa.gov/environmental-economics/mortality-risk-valuation

It disproportionately affects old people which should inform the analysis.  The value of a statistical life is not adjusting for age.  Why do you think hospitals give preference in triage situations to younger, healthier patients?  Is it because they value every life equally?

[Kat Kid]

justwin—can you post in the investing thread about what your model suggests about unemployment and gdp for the next year in various scenarios?

[michigancat]

Justwin, why are you using QALY's instead of value of statistical life? Just because you think it only impacts old people? value of statistical life seems much more relevant to pandemic poliicy than how QALY is used with NICE in the UK.

In the scientific literature, these estimates of willingness to pay for small reductions in mortality risks are often referred to as the "value of a statistical life.” This is because these values are typically reported in units that match the aggregate dollar amount that a large group of people would be willing to pay for a reduction in their individual risks of dying in a year, such that we would expect one fewer death among the group during that year on average. This is best explained by way of an example. Suppose each person in a sample of 100,000 people were asked how much he or she would be willing to pay for a reduction in their individual risk of dying of 1 in 100,000, or 0.001%, over the next year. Since this reduction in risk would mean that we would expect one fewer death among the sample of 100,000 people over the next year on average, this is sometimes described as "one statistical life saved.” Now suppose that the average response to this hypothetical question was $100. Then the total dollar amount that the group would be willing to pay to save one statistical life in a year would be $100 per person × 100,000 people, or $10 million. This is what is meant by the "value of a statistical life.” Importantly, this is not an estimate of how much money any single individual or group would be willing to pay to prevent the certain death of any particular person.

https://www.epa.gov/environmental-economics/mortality-risk-valuation

It disproportionately affects old people which should inform the analysis.  The value of a statistical life is not adjusting for age.  Why do you think hospitals give preference in triage situations to younger, healthier patients?  Is it because they value every life equally?

even if it just impacts old people, your QALY calculation is about 3% of the VSL figure currently used by the EPA and even less than the VSL other agencies use when making policy recommendations. Your QALY estimate is so low that everyone living 100 years wouldn't come close to the VSL used by most agencies

Also hospitals in the US haven't had to deal with triage situations where they have to decide between providing either an old person or a young person life-saving treatment. The system's designed with enough capacity so pretty much everyone who needs life-saving treatment can get it in normal times. I don't know how you thought this happened in hospitals in the US

[mocat]

yeah nevermind i actually prefer blacked out wacky yelling at tbt

[chum1]

Lol

[bucket]

https://twitter.com/RandPaul/status/1241780756617273345

karma

[Justwin]

Justwin, why are you using QALY's instead of value of statistical life? Just because you think it only impacts old people? value of statistical life seems much more relevant to pandemic poliicy than how QALY is used with NICE in the UK.

In the scientific literature, these estimates of willingness to pay for small reductions in mortality risks are often referred to as the "value of a statistical life.” This is because these values are typically reported in units that match the aggregate dollar amount that a large group of people would be willing to pay for a reduction in their individual risks of dying in a year, such that we would expect one fewer death among the group during that year on average. This is best explained by way of an example. Suppose each person in a sample of 100,000 people were asked how much he or she would be willing to pay for a reduction in their individual risk of dying of 1 in 100,000, or 0.001%, over the next year. Since this reduction in risk would mean that we would expect one fewer death among the sample of 100,000 people over the next year on average, this is sometimes described as "one statistical life saved.” Now suppose that the average response to this hypothetical question was $100. Then the total dollar amount that the group would be willing to pay to save one statistical life in a year would be $100 per person × 100,000 people, or $10 million. This is what is meant by the "value of a statistical life.” Importantly, this is not an estimate of how much money any single individual or group would be willing to pay to prevent the certain death of any particular person.

https://www.epa.gov/environmental-economics/mortality-risk-valuation

It disproportionately affects old people which should inform the analysis.  The value of a statistical life is not adjusting for age.  Why do you think hospitals give preference in triage situations to younger, healthier patients?  Is it because they value every life equally?

even if it just impacts old people, your QALY calculation is about 3% of the VSL figure currently used by the EPA and even less than the VSL other agencies use when making policy recommendations. Your QALY estimate is so low that everyone living 100 years wouldn't come close to the VSL used by most agencies

Also hospitals in the US haven't had to deal with triage situations where they have to decide between providing either an old person or a young person life-saving treatment. The system's designed with enough capacity so pretty much everyone who needs life-saving treatment can get it in normal times. I don't know how you thought this happened in hospitals in the US

$125,000*80= $10,000,000

[Justwin]

Justwin, why are you using QALY's instead of value of statistical life? Just because you think it only impacts old people? value of statistical life seems much more relevant to pandemic poliicy than how QALY is used with NICE in the UK.

In the scientific literature, these estimates of willingness to pay for small reductions in mortality risks are often referred to as the "value of a statistical life.” This is because these values are typically reported in units that match the aggregate dollar amount that a large group of people would be willing to pay for a reduction in their individual risks of dying in a year, such that we would expect one fewer death among the group during that year on average. This is best explained by way of an example. Suppose each person in a sample of 100,000 people were asked how much he or she would be willing to pay for a reduction in their individual risk of dying of 1 in 100,000, or 0.001%, over the next year. Since this reduction in risk would mean that we would expect one fewer death among the sample of 100,000 people over the next year on average, this is sometimes described as "one statistical life saved.” Now suppose that the average response to this hypothetical question was $100. Then the total dollar amount that the group would be willing to pay to save one statistical life in a year would be $100 per person × 100,000 people, or $10 million. This is what is meant by the "value of a statistical life.” Importantly, this is not an estimate of how much money any single individual or group would be willing to pay to prevent the certain death of any particular person.

https://www.epa.gov/environmental-economics/mortality-risk-valuation

It disproportionately affects old people which should inform the analysis.  The value of a statistical life is not adjusting for age.  Why do you think hospitals give preference in triage situations to younger, healthier patients?  Is it because they value every life equally?

even if it just impacts old people, your QALY calculation is about 3% of the VSL figure currently used by the EPA and even less than the VSL other agencies use when making policy recommendations. Your QALY estimate is so low that everyone living 100 years wouldn't come close to the VSL used by most agencies

Also hospitals in the US haven't had to deal with triage situations where they have to decide between providing either an old person or a young person life-saving treatment. The system's designed with enough capacity so pretty much everyone who needs life-saving treatment can get it in normal times. I don't know how you thought this happened in hospitals in the US

https://www.npr.org/2020/03/21/819645036/u-s-hospitals-prepare-guidelines-for-who-gets-care-amid-coronavirus-surge

Every accredited hospital in the U.S. is required to have some mechanism for addressing ethical issues like this — typically, an ethics committee made up of not just medical professionals but often also social workers, pastors and patient advocates. Sometimes in partnership with hospital triage committees, they create guidelines for prioritizing patient care if there's a resource shortage.

As the number of coronavirus cases rises in the U.S., hospitals have a new urgency in revisiting and updating those guidelines.

They vary from hospital to hospital, but their overall goal is usually to save the most lives. So hospitals consider a combination of factors: age, life expectancy, how severe a patient's illness is, how likely treatment is to help and whether a patient has additional illnesses that could shorten the person's life span, such as cancer or heart disease. Hospitals can then use those factors to develop scoring systems or clinical scores to prioritize care.

[michigancat]

The thing is they haven't had to put that into practice

[Justwin]

So is your baseline 2 million dying then and 3 trillion? Just curious if you're going to number crunch 18 months from now.

I mean maybe they did the math. Cause the estimated death toll reported to the WH was over the number you think would justify the measures we’re taking.

Sweeping new federal recommendations announced on Monday for Americans to sharply limit their activities appeared to draw on a dire scientific report warning that, without action by the government and individuals to slow the spread of coronavirus and suppress new cases, 2.2 million people in the United States could die.

https://www.nytimes.com/2020/03/16/us/coronavirus-fatality-rate-white-house.html

The current measures being undertaken were not and are not going to save all of those people and current measures are not as severe as what is in the report.  Even in the report, they don't claim that all of those people are going to be saved. 

We find that that optimal mitigation policies (combining home isolation of suspect cases, home quarantine of those living in the same household as suspect cases, and social distancing of the
elderly and others at most risk of severe disease) might reduce peak healthcare demand by 2/3 and deaths by half. However, the resulting mitigated epidemic would still likely result in hundreds of
thousands of deaths and health systems (most notably intensive care units) being overwhelmed many times over.

Additionally, you have to implement these policies for 18 months to get the maximum number of deaths averted.  People will not stand for these measures enduring for many months, let alone for 18 months.  The report is also based on an IFR or CFR of 0.9%, which is likely double what it truly is.  This has a big impact on the potential benefits.

There will be many economic studies done for many years after this is through.  I plan on looking at them and forming an opinion based on their assumptions and data used.

https://www.nytimes.com/2020/03/20/opinion/sunday/coronavirus-outcomes.html

Now we get to the other end of the range of possibilities. Dr. Neil M. Ferguson, a British epidemiologist who is regarded as one of the best disease modelers in the world, produced a sophisticated model with a worst case of 2.2 million deaths in the United States.

I asked Ferguson for his best case. “About 1.1 million deaths,” he said.

The 2.2 million deaths is the worst case scenario according to the Imperial College report.  With their assumptions, the best-case scenario with all of the restrictions in place for 18 months is 1.1 million deaths.  That means the worst-case scenario benefit is 1.1 million deaths averted.

If you read the rest of the article, I'm much more in the best-case scenario being more likely camp.  This means the deaths averted are much lower than 1.1 million.

I think $1.5-$3 trillion is not an unreasonable estimate for the economic costs in terms of lost production and unemployment.

[catastrophe]

I mean maybe they did the math. Cause the estimated death toll reported to the WH was over the number you think would justify the measures we’re taking.

Sweeping new federal recommendations announced on Monday for Americans to sharply limit their activities appeared to draw on a dire scientific report warning that, without action by the government and individuals to slow the spread of coronavirus and suppress new cases, 2.2 million people in the United States could die.

https://www.nytimes.com/2020/03/16/us/coronavirus-fatality-rate-white-house.html

The current measures being undertaken were not and are not going to save all of those people and current measures are not as severe as what is in the report.  Even in the report, they don't claim that all of those people are going to be saved. 

We find that that optimal mitigation policies (combining home isolation of suspect cases, home quarantine of those living in the same household as suspect cases, and social distancing of the
elderly and others at most risk of severe disease) might reduce peak healthcare demand by 2/3 and deaths by half. However, the resulting mitigated epidemic would still likely result in hundreds of
thousands of deaths and health systems (most notably intensive care units) being overwhelmed many times over.

Additionally, you have to implement these policies for 18 months to get the maximum number of deaths averted.  People will not stand for these measures enduring for many months, let alone for 18 months.  The report is also based on an IFR or CFR of 0.9%, which is likely double what it truly is.  This has a big impact on the potential benefits.

I gotta be honest, it feels like you’re moving the goalposts which is a bunch of malarkey IYAM.

I asked what projected death total would justify our current measure and you said 1-2 million. Now you’re telling me that’s only if you could guarantee it would save the entire 1-2 million?

[Justwin]

The thing is they haven't had to put that into practice

Do you think they're going to violate their guidelines which are already written.  The guidelines where, when they were written for the hospital, the hospital did not value all lives equally.